Abstracts

Women can deliver safely without controlled traction on the cord

Controlled traction on the umbilical cord helps deliver the
placenta, but it has little impact on a woman’s risk of
postpartum haemorrhage, say researchers. Cord traction can be omitted
safely in women who deliver without the help of properly trained birth
attendants.

Their large trial compared active management of the third stage of labour with and without cord traction in more than 24 000 women having a single vaginal delivery. Roughly 2% of women in both groups lost a litre or more of blood (239/
11 621 v. 219/11 621; risk ratio (RR) 1.09, 95% confidence interval (CI) 0.91 - 1.31).

Management without cord traction wasn’t conclusively
‘non-inferior’ (primary results just missed a prespecified
threshold), but women managed this way lost just 10 ml more blood than
controls (3.9 - 16.4). Cord traction shortened the third stage by an
average of 6.5 minutes (6.2 - 6.8). The practice seemed safe in this
trial but may not be so safe in poorly trained hands, says an editorial
(doi:10.1016/S0140-6736(12)60354-7). Uterine inversion is rare but can
be life-threatening.

A uterotonic such as oxytocin, not controlled traction on the
cord, is the most important component of a managed third stage, says
the editorial. Women in this trial had 10 IU of oxytocin immediately
after delivery of the baby, and overall rates of bleeding were low.

Administration of a uterotonic is relatively easy with
disposable syringes prefilled with oxytocin and easier still with
tablets of misoprostol. International agencies trying to reduce
maternal mortality now have a better idea where to direct scarce
resources.